P-072: COST COMPARISON OF TRANSFUSION CHOICES IN OMAN FOR PATIENTS SUFFERING FROM SICKLE CELL DISEASE.
Authors: AL KINDI S., AL HASHAMI S., DIERICK K., SWEERTS L., DOSHI S.
Journal: HemaSphere (2022)

Purpose: The management of sickle cell disease (SCD) can be challenging, requiring different therapeutic approaches because SCD could induce multiple complications, precipitating multi-organ failure. Red blood cell (RBC) transfusion is well known as one of the disease-modifying therapies available for long-term management of this condition. It is supported by multiple randomised clinical trials for the prevention of disease complications such as stroke in adults and children with SCD. RBCs can be delivered via three methods: Simple transfusion(ST), manual exchange(ME) and automated red blood cell exchange(aRBCX). In a simple transfusion, patients receive additional units of blood. The purpose is to raise the haemoglobin (Hb) to a steady state and maintain the oxygen-carrying capacity of the blood. Manual exchange transfusion removes the patient’s sickle-shaped RBCs and replaces them with healthy ones — lowering the concentration of sickled cells without increasing blood viscosity. This is performed using repeated alternating isovolumetric phlebotomy and blood transfusion. Automated red blood cell exchange transfusion involves removing sickled RBCs from the patient and rapid replacement with healthy RBCs while maintaining isovolemia. An advantage of aRBCX is avoiding or minimising costly iron chelation therapy to treat iron overload. As Sickle Cell disease (SCD) management is a critical cost driver to health systems, this research intended to compare the cost-effectiveness of different transfusion modalities. We wanted to compare the following transfusion types: Automated red blood cell exchange (aRBCX), Top-up transfusion and Manual red blood cell exchange (mRBCX). More specifically, we wanted to perform this evaluation in Oman as 0.2% of the Omani population suffers from this disease, which is the most frequent genetic disorder with the highest incidence. Materials and methods: Variables that drive costs have been collected to populate a de Novo cost model. We collected data from the Royal Hospital and Sultan Qaboos University Hospital. The most significant cost drivers which we took into consideration were: disease incidence, cost blood transfusion, medical equipment, disposables, complications, chelation therapy, hospitalisation, lives lost. Results: Our results reflect a 5-year overview demonstrating the costs and benefits experienced by healthcare providers. When considering the cost of treatment, consequence, complications, lives lost, life years lost, aRBCX is dominant over the transfusion modalities. Yearly intervention cost per patient per year in Omani-Rial: [Top-up 1933.5;Manual 3101.5;aRBCX 5857.5].The yearly cost of treatment choice related cost per patient per year in Omani-Rial:[12128.88; 6233.41; 789.88].Cost of disease complications per patient per year in Omani-Rial:[12706;12864; 11346].Cost of lives lost per patient per year in Omani-Rial:[1315;1288;1102). The total yearly cost per patient per year in Omani-Rial is estimated:[28084;23487.5;19095] Conclusion: aRBCX is 47% more cost-effective when compared to Top-up transfusion. aRBCX is 23% more cost-effective when compared to mRBCX. aRBCX promotes reduction in overall resources, disease burden, bed retention and the need for chelation therapy when compared to top-up transfusion and manual exchange transfusion. Cost savings may lead to better adoption. We recommend researchers rerun these calculations on an individual hospital basis.The authors do not declare any conflict of interest